Clinical Conversations

In this episode Professor Tom Fardon returns to Clinical Conversations to discuss updates in asthma diagnosis and management from the joint BTS/SIGN/NICE guideline on Asthma. Prof Fardon and Dr Ben Warner discuss the changes to practice since the guidelines were released and the evolving role of biologics in asthma treatment.

Professor Fardon is a Consultant Respiratory Physician at NHS Tayside and Honorary Professor at the University of Dundee. They are also the chair of the Scottish Severe Asthma Group within the Centre for Sustainable Delivery.

Dr Ben Warner is a Respiratory Medicine Specialty Registrar with clinical and academic experience of global public health. He is currently undertaking a PhD in multimorbidity in Malawi as part of the Wellcome-funded Multimorbidity PhD Programme for Health Professionals with the University of Glasgow.

Recording Date: 9 December 2025

--Links--

BTS/SIGN/NICE guideline on Asthma - https://www.nice.org.uk/guidance/ng245

Asthma Pathway - https://www.nice.org.uk/guidance/ng244

Algorithm A: Objective tests for diagnosing asthma in adults and young people (aged over 16 years) - https://www.nice.org.uk/guidance/ng245/resources/bts-nice-and-sign-algorithm-a-summary-of-objective-tests-for-diagnosing-asthma-pdf-13556516365

Algorithm C: Pharmacological management of asthma in people aged 12 years and over - https://www.nice.org.uk/guidance/ng245/resources/algorithm-c-pharmacological-management-of-asthma-in-people-aged-12-years-and-over-bts-nice-pdf-13556516367

‘Optimising inhaled therapy for patients with asthma’- https://doi.org/10.1136/bmj-2024-080353

Asthma+Lung UK website Inhalers resource - https://www.asthmaandlung.org.uk/living-with/inhaler-videos

‘Greener Practice’ asthma care toolkit (free registration required)- https://www.greenerpractice.co.uk/asthma-toolkit/

'Greener Practice' Device Choice video - https://www.youtube.com/watch?v=YRJGD48bryI

Asthma Guidelines (Plain Language Version) - https://www.sign.ac.uk/patient-public-involvement/plain-language-versions-of-guidelines/asthma/

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This podcast is from the Trainees & Members' Committee (T&MC) of the Royal College of Physicians of Edinburgh (RCPE).

This is a co-release with our sister podcast, Career Conversations.

In this episode, Dr Marilena Giannoudi talks with Dr Manav Sharma about the specialty, Aerospace Medicine. They discuss the pathways which lead to the specialty and some interesting cases.

Dr Manav Dutt Sharma is an aerospace medicine physician, former Indian Air Force flight surgeon and human factors specialist with over 23 years of experience at the intersection of aviation and healthcare. He has led an award‑winning primary healthcare centre in the Air Force, works on safety, service quality and systems improvement in hospitals, and has authored a forthcoming book, From Runways to Recovery Rooms, on what healthcare can learn from aviation.

Dr Marilena Giannoudi is a cardiology registrar based in Leeds. She is Co-Chair of the Trainees and Members & Committee, a Fellow of the Higher Education Academy, and is currently undertaking a PhD.

Recording Date: 12 December 2025

--Links--

JRCPTB Specialty - https://www.thefederation.uk/training/specialties/aviation-and-space-medicine

Physician Higher Specialty Training Recruitment - https://www.phstrecruitment.org.uk/

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This podcast is from the Trainees & Members' Committee (T&MC) of the Royal College of Physicians of Edinburgh (RCPE).

In this episode, Dr Aoife Duignan speaks with Dr Mireia Moragas about how to treat headaches in a pregnant person. They discuss what questions physicians should ask themselves when a pregnant person attends the acute ward with headaches, the green and red flags for headaches as well as the medications that are safe during pregnancy.

Dr Mireia Moragas is a Consultant Neurologist in Edinburgh where she also runs the Headache Clinic, as well as participating in the acute care of patients with stroke. She has participated in the local and Scottish national headache guidelines as well as the local protocols for management of headache and stroke during pregnancy.

Dr Aoife Duignan is a specialist trainee in geriatric and general medicine in South East Scotland. She is also Co-Chair & Vice Chair - Representation for the Trainees and Members' Committee (T&MC).

Recording date: 10 November 2025

--Useful Links--

Bumps (Best Use of Medicines in Pregnancy) - https://www.medicinesinpregnancy.org/

Maternity pathway and schedule of care - https://www.gov.scot/publications/maternity-pathway-schedule-care-clinical-guidance-schedule/

National Maternity Network, Management of Headache in Pregnancy Guidance - https://www.perinatalnetwork.nhs.scot/wp-content/uploads/2023/02/2023-02-21-Headache-in-Pregnancy.pdf

NHS Scotland Centre for Sustainable Delivery - https://www.nhscfsd.co.uk/media/nswenkmf/national-headache-pathway-migraine-during-pregnancy-and-following-childbirth.pdf

RefHelp NHS Lothian - https://apps.nhslothian.scot/refhelp/

RefHelf Migraine/Chronic Headache in pregnancy - https://apps.nhslothian.scot/refhelp/guidelines/neurology/headache/migraine-chronic-headache-in-pregnancy/

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This podcast is from the Trainees & Members' Committee (T&MC) of the Royal College of Physicians of Edinburgh (RCPE).

In this episode of Clinical Conversations, Dr Marilena Giannoudi discusses cardiorenal metabolic disease with Dr Andrew Frankel. Their discussion provides an overview of this common cause of chronic kidney disease (CKD) and they focus on the management of cardiorenal metabolic disease, with Dr Frankel highlighting the importance of lifestyle management and patient education and engagement, and the pharmacotherapy 'four pillars' of RAAS inhibition, SGLT2 inhibition, blood pressure control, and MR antagonism. Explore this and more in this episode.

Dr Andrew Frankel has been working as a consultant nephrologist at Imperial College Healthcare NHS trust since 1995 and works at the Imperial Renal and Transplant Centre, which is one of the largest kidney units in Europe catering for a population base of over three million. He has experience in managing all aspects of kidney disease but has a particular interest in relation to the management of kidney disease in the context of diabetes, cardiac disease and obesity.

Dr Marilena Giannoudi is a cardiology registrar based in Leeds. She is Co-Chair of RCPE's Trainees and Members' Committee.

-- Links --

NICE Guideline (NG203) - Chronic kidney disease: assessment and management

https://www.nice.org.uk/guidance/ng203

2023 ESC Guidelines for the management of cardiovascular disease in patients with diabetes

https://www.escardio.org/Guidelines/Clinical-Practice-Guidelines/CVD-and-Diabetes-Guidelines

For Kidneys Sake Podcast - By Dr Andrew Frankel and colleagues

https://www.forkidneyssake.com/

Recording date: 24 November 2025

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This podcast is from the Trainees & Members' Committee (T&MC) of the Royal College of Physicians of Edinburgh (RCPE).

In this episode, Dr Kat Ralston speaks to Professor Edwin Jesudason about how his experience of whistleblowing as a paediatric surgeon changed his practice. They reflect on the importance of listening and creating a shared dialogue with patients, discuss how experiencing moral injury can help clinicians better understand and navigate patient suffering and explore the art of being human in medicine.

Professor Edwin Jesudason is a Consultant in Rehabilitation Medicine in NHS Lothian.

Dr Kat Ralston is a geriatric medicine registrar in Edinburgh. She is also the Education Co-Vice Chair and the joint Podcast Lead for the RCPE Trainee & Members' Committee (T&MC).

Recording date: 24 July 2025

-- Useful Links --

Jesudason, 'The 4D Model: Rehabilitating Unrealistic Medicine', BJHM (2025) https://doi.org/10.12968/hmed.2024.084

Jesudason, 'Manufacturing safer medics', J Med Ethics (2022) https://doi.org/10.1136/jme-2022-108581

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This podcast is from the Trainees & Members' Committee (T&MC) of the Royal College of Physicians of Edinburgh (RCPE).

In this episode, Dr Kat Ralston speaks to Dr Jane Rimer about a challenging clinical case which had an unexpected outcome. They discuss the importance of reflection with trusted colleagues and consider systems to help us cover the basics well. They explore how we can reduce the sense of isolation and vulnerability that is often encountered when we have to navigate complaints, adverse event reviews and legal processes, as illustrated by the title 'Defence against The Dark Arts'.

Dr Jane Rimer is a Consultant Physician and Geriatrician in NHS Lothian. She is also Associate Postgraduate Dean for Medical Training in South East Scotland.

Dr Kat Ralston is a geriatric medicine registrar in Edinburgh. She is also the Education Co-Vice Chair and the joint Podcast Lead for the RCPE Trainee & Members' Committee (T&MC).

Recording Date: 29 July 2025

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This podcast is from the Trainees & Members' Committee (T&MC) of the Royal College of Physicians of Edinburgh (RCPE).

In this episode, Dr Marilena Giannoudi hears about a case that changed the practice of Professor James Dear.

They discuss the challenges of caring for a patient without a diagnosis, who to talk to if you are feeling uncertain in how to treat a patient, and how you can own up to and move on from mistakes you may make.

Professor James Dear is a Consultant in Clinical Pharmacology at the Royal Infirmary of Edinburgh and Personal Chair of Clinical Pharmacology at the Centre for Cardiovascular Science at the University of Edinburgh.

Dr Marilena Giannoudi is a cardiology registrar based in Leeds. She is Co-Chair of the Trainees and Members & Committee, a Fellow of the Higher Education Academy, and is currently undertaking a PhD.

Recording date: 9 June 2025

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This podcast is from the Trainees & Members' Committee (T&MC) of the Royal College of Physicians of Edinburgh (RCPE).

In this episode, Dr Kat Ralston hears about a case that changed the practice of Dr Chris Tiplady. They discuss the importance of recognising when a patient may be entering the last phase of life, what we owe to patients and families in understanding what matters to them, and how we can navigate managing uncertainty and being wrong as clinicians.

Dr Chris Tiplady has been a Consultant Haematologist in Northumbria since 2001 and has held a number of roles in postgraduate and undergraduate medical education over the years. He has been a Director of Medical Education in two trusts and now leads the Master of Medical Education course at Sunderland University. He also has a regular blog published by the Royal College of Pathologists, discussing professionalism in medicine.

Dr Kat Ralston is a geriatric medicine registrar in Edinburgh. She is also the Education Co-Vice Chair and the joint Podcast Lead for the RCPE Trainee & Members' Committee (T&MC).

Recording date: 14 April 2025

-- Useful Links --

NHS England, Last 1000 days - https://www.youtube.com/watch?v=HynytVepxZc

REDMAP toolkit for future care planning conversations - https://www.spict.org.uk/red-map/

The King's Fund, Patients' preferences matter: stop the silent misdiagnosis (May 2012) - https://www.kingsfund.org.uk/insight-and-analysis/reports/patients-preferences-matter

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This podcast is from the Trainees & Members' Committee (T&MC) of the Royal College of Physicians of Edinburgh (RCPE).

In this episode of Clinical Conversations, Dr Aoife Duignan chats with Dr Claire Steel and Dr Shelagh O'Riordan about Hospital at Home.

They explore what Hospital at Home is, and the evidence base behind it, thinking through which patients may benefit from it. They also consider how technology can enable patients to receive care in their own homes and what a day in the life might look like. Finally they consider some top tips for becoming involved with Hospital at Home.

Dr Claire Steel is a consultant physician in older people’s medicine in NHS Lanarkshire. She is the President of the UK Hospital at Home Society and clinical lead for Hospital at Home in NHS Lanarkshire. She works closely with Healthcare Improvement Scotland to support the growth and development of H@H in Scotland.

Dr Shelagh O'Riordan is a consultant physician and lead for the Hospital at Home service in East Kent. She is President Elect of the UK Hospital at Home Society and National Clinical Lead for Hospital at Home/Virtual Wards for NHS England.

Dr Aoife Duignan is a geriatric medicine registrar in Edinburgh. She is also the Representation Co-Vice Chair for the RCPE Trainees and Members' Committee (T&MC).

Recording date: 16 April 2025

-- Useful links --

Hospital at Home Society Health Improvement Scotland Toolkit - https://www.ihub.scot/project-toolkits/hospital-at-home-toolkit/hospital-at-home-toolkit/

Hospital at Home RCT - https://pubmed.ncbi.nlm.nih.gov/35129936/

PPL South East Region Virtual Wards Evaluation - https://ppl.org.uk/what-we-do/virtual-wards-consultancy/

Cochrane Review - https://www.cochrane.org/CD007491/EPOC_hospital-home-services-avoid-admission-hospital

UK Hospital at Home Society - https://www.hospitalathome.org.uk/

NHS England Virtual wards operational framework - https://www.england.nhs.uk/long-read/virtual-wards-operational-framework/

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This podcast is from the Trainees & Members' Committee (T&MC) of the Royal College of Physicians of Edinburgh (RCPE).

In this episode Dr Emma Spencer discusses decompensated cirrhosis with Dr Michael Williams. This discussion includes the definition of a decompensation event, how to recognise these events on the medical take and the importance of doing so. They also discuss key steps in investigating causes of decompensations of cirrhosis and how to manage these unwell patients.

Dr Michael Williams is a consultant hepatologist, working on the Scottish Liver Transplant Unit in Edinburgh. His clinical interests are liver transplantation and autoimmune liver disease.

Dr Emma Spencer is an IMT3 doctor in the South East of Scotland and a member of the RCPE's Trainees & Members' Committee (T&MC).

Recording date: 13 March 2025

-- Useful Links --

BSG/BASL Decomp Cirrhosis Care Bundle - https://www.bsg.org.uk/clinical-resource/bsg-basl-decompensated-cirrhosis-first-24-hours

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This podcast is from the Trainees & Members' Committee (T&MC) of the Royal College of Physicians of Edinburgh (RCPE).